International Journal of Surgery Open最新文献

Introduction

Cholelithiasis is a rare abdominal condition in children. The cause of pediatric cholelithiasis is unclear, and the most commonly occurring type is pigment stones due to hemolytic diseases and other causes such as medications, hepatobiliary tract anomalies, and genetic problems. Asymptomatic patients require monitoring, whereas symptomatic patients require surgical removal of the gall bladder (cholecystectomy), which can be performed using open or laparoscopic techniques. Here, we present two cases of cholelithiasis (symptomatic and asymptomatic) with neglect of proper medical management until a definite diagnosis and surgical treatment.

Case presentation

A 13-year-old and an 11-year-old child were presented with the diagnosis of cholelithiasis to our pediatric surgery department. The earlier patient suffered from jaundice in early childhood and was treated with the traditional method (non-surgical home remedy using an onion). Later, he was diagnosed with multiple gallbladder stones. The later patient was asymptomatic until his hospitalization at the age of 11 years, when he was diagnosed with a single gallbladder stone (epigastric pain after heavy meals as a chief complaint). Both patients were symptomatic, so we decided to plan them for definite treatment. The patients underwent cholecystectomy with no complications and were discharged from the hospital in satisfactory condition.

Clinical discussion

However, cholelithiasis is uncommon in children, but recent reports indicate increased detection of the disease. In developed nations, an increase in childhood obesity has risen the rate of gallstone cases in the pediatric population. Typically, pediatric cholelithiasis is asymptomatic, but symptomatic children may present with biliary colic as the sudden onset of recurrent epigastric or right upper quadrant (RUQ) pain radiating to the back or right shoulder. In young children, the episodes are accompanied by nausea, vomiting, and fever. Many times, the pain develops without precipitating factors, and fat intolerance is an inconsistent feature. The management of cholelithiasis requires a concise work-up regarding its cause in children.

Conclusion

Cholelithiasis has different underlying causative factors. In otherwise healthy children, surgical treatment is only warranted in symptomatic cases.

Background

Current study aims to investigate pre-surgical medical intervention on the reduction of POUR incidence in patients undergoing spine surgery.

Method

The study was a single center double-blind randomized placebo clinical trial. Participants were individuals over 18 years old who underwent spinal surgery at the Educational and Therapeutic Hospital between 2020 and 2023. Inclusion criteria included the ability to provide informed consent and follow the study schedule, while exclusion criteria included certain medical conditions, current medication use, and inability to take oral medication after surgery.

Results

The study enrolled 100 patients. There was no significant difference in age or gender distribution between the tamsulosin and placebo groups, but the tamsulosin group had a lower prevalence of diabetes. The duration of surgery was shorter in the tamsulosin group, and there was no significant difference in the surgical site. The tamsulosin group had significantly less post-void residual volume on the eighth day of the study, but there were no significant differences in urine output volume during surgery or residual urine volume before or after surgery.

Conclusion

Tamsulosin may be effective in preventing postoperative urinary retention (POUR), but its effectiveness in treating established POUR is uncertain. The Tamsulosin group had significantly lower post-void residual volume after spine surgery. Considering the low risk of adverse effects, Tamsulosin could be considered for high-risk patients. However, patients should be aware of potential risks and seek medical attention if they experience adverse effects. Further research is needed to determine the best dosage and duration of treatment.

Introduction

and importance: Meningioma, also known as meningeal tumor, is a primary tumor of the central nervous system (CNS). Originates from arachnoid cap cells.

Case presentation

A 65-year-old female patient presented with hard, painless swelling in the right parieto-fronto-temporal region of the skull, which has been growing for the past 6 months. And computed tomography (CT) scans revealed a lytic lesion. The patient underwent a cranitotomy and Resection of tumor with safe margins were performed, after the operation, the patient was neurologically intact and the patient was discharged in stable condition after disappeared the symptoms.

Discussion

Extradural meningiomas make up a small percentage, approximately 1–2%, of all meningiomas, This type of mass comprise a small percentage of all meningiomas, with primary intraosseous meningiomas commonly found in frontotemporal orbits, anterior cranial fossa, paranasal sinuses, nasal cavity, neck, and petrous region of the temporal.

Conclusion

Here we present a case of primary intraosseous meningiomas although the origin of this tumor is not well understood, but usually present with the osteoblastic type or osteolytic lesion in rere case.

Caesarean section is the operative intervention for the delivery of a fetus that is unable to deliver vaginally due to indications like obstructed labor, cephalo-pelvic disproportion, etc. Recent studies indicate a rising trend in the number of C-sections performed annually and the impact it may have on maternal and fetal well-being.

Introduction and clinical importance

Teratomas are neoplasms originating from pluripotent cells, rising from more than one or all three embryonic germinal layers. The nomenclature “Teratoma” is derived from the Greek word “teras” which translates to the word “monster”. One of the rarest locations is the adrenal gland, with adrenal teratomas representing only 0.13 % of all adrenal tumors.

Case presentation

A 36-year-old female, morbidly obese, was found to have a right adrenal mass after she presented to our surgical outpatient clinic with a complaint of abdominal pain. The mass was found on an abdominal computed tomography (CT) scan, which revealed a large retroperitoneal lesion measuring 29 × 15 × 22 cm and displacing the IVC, pancreas, duodenum, right kidney, and ascending colon. The differential diagnosis based on the patient's workup was adrenal teratoma, myolipoma, angiolipoma, and liposarcoma. The patient underwent an uneventful open right adrenalectomy. The final histopathology confirmed the diagnosis of a mature right adrenal cystic teratoma weighing 4 kg. The last follow-up was 3 years postoperatively with no evidence of recurrence on CT scan.

Clinical discussion

A thorough discussion of the clinical presentations of the reported cases in the literature including the first reported case in the English literature. Furthermore, the use of the different modalities of diagnosis e.g., Ultrasonography, CT scan, and MRI. Also, the mainstay modality of treatment and the debate of minimal invasive laparoscopic adrenalectomy vs open adrenalectomy. Finally, the discussion of the period of following up the patient after successful operation and the removal of the tumor were presented.

Conclusion

Adrenal teratoma is extremely uncommon entity, with a great percentage of patient presenting with a non-specific presentation or are asymptomatic. Initial diagnosis might be made radiologically. However, a confirmatory diagnosis is based on the histopathological examination. The workup must rule out other possible differential diagnoses, like metastastis or functional tumors. Finally, surgical resection is the mainstay treatment of adrenal teratoma with an excellent survival rate.

Introduction

Surgical abdominal emergencies in children are responsible for high morbidity and mortality. They are numerous and their management in Africa is difficult. The management of non-traumatic abdominal emergencies in children in a regional hospital in Togo is described.

Method

and study setting: This was a single-center, retrospective and descriptive study conducted over a 12-month period. It included all children aged 0–15 years treated at the hospital for non-traumatic abdominal surgical emergencies.

Results

We reported 217 cases of non-traumatic abdominal surgical emergencies in children. We noted a male predominance with a sex ratio of 1.57. Similarly, grandchildren were predominant (44.70 %). A low school attendance rate was noted (21.20 %) and the children were mostly from poor families (32.72 %). The average consultation time was 5.3 ± 1.03 days. Pain was the main symptom and was present in all children. An unprepared abdominal X-ray was the main imaging procedure performed (77.18 %). These conditions were dominated by peritonitis (56.68 %). These were mainly ileal perforations. All the children received surgical treatment. The postoperative course was marked by complications in 104 children (47,93 %) and 14 deaths (6,45 %).

Conclusion

Non-traumatic abdominal surgical emergencies in children are dominated by peritonitis in rural Togo. They could be related to poverty. An effective policy of universal access to health care is essential.

The text explores the negative aspects of dieting. Dieting has been more common in recent years as more people strive to adhere to strict food plans in an effort to achieve their desired body weight and form. Unfortunately, this strategy may have unforeseen repercussions that could have a negative impact on one's health. Insufficient calorie intake, for instance, might deprive the body of vital nutrients, resulting in malnutrition and a weakened immune system. Similar to too-restricted diets, irregular periods and even infertility can result from a disruption in the hormonal balance. Furthermore, dieting can lead to psychological distress, which in turn promotes disordered eating behaviors such as binge eating, purging, and other eating disorders. These disorders have the potential to have a long-term negative impact on physical and mental health, and in some situations, they may even be fatal. It's important to exercise caution and knowledge when it comes to various diet regimens that are advertised on social media and online.

Introduction and Importance

Congenital bronchopulmonary foregut malformation (CBPFM) is a rare anomaly in which either a lung, a lung lobe or a segment has a patent congenital communication to the upper gastrointestinal tract. In esophageal lung, an anomalous main bronchus arises from the esophagus rather than the trachea.

Case presentation

A male neonate was admitted with respiratory distress immediately following birth. Radiographic evaluation included chest radiograph, chest Ultrasound, chest CT and an upper gastrointestinal (GI) contrast study. A completely opaque right hemithorax was initially visualized and identified as esophageal lung with associated anomalous partial systemic arterial supply and venous drainage. A right posterolateral thoracotomy with pneumonectomy of the hypoplastic lung was performed. However, the patient died of respiratory failure on the first postoperative day.

Clinical discussion

Esophageal lung is an extremely rare form of CBPFM in which a main stem bronchus, usually the right one, is abnormally connected to the esophagus. The diagnosis is suggested by chest x-ray and confirmed by upper GI contrast study, which is also available in resource-poor settings. A CT scan with 3D volume rendered images can make a diagnosis, although difficulties remain. Pneumonectomy is the preferred treatment for most patients.

Conclusion

Esophageal lung is a rare congenital abnormality with few reported cases. Radiologists and pediatricians should have a high index of suspicion for this anomaly in cases of neonatal respiratory distress and a persistently opacified lung with focal air bronchogram(s) and pursue a timely confirmatory contrast study.